SURG.00026 Deep Brain, Cortical, and Cerebellar Stimulation

This policy addresses neuromodulation procedures, including deep brain stimulation (DBS), cortical stimulation, and cerebellar stimulation/pacing. Unilateral or bilateral DBS is covered for Parkinson’s disease only when the patient has a motor UPDRS score ≥30 after 12 hours off medication and either pharmacologically uncontrollable motor complications or tremor. All other uses are investigational/not medically necessary, including DBS when criteria are not met, any cortical or cerebellar stimulation, and revision/replacement of stimulators or batteries if initial coverage criteria are not met.

"Unilateral or bilateral deep brain stimulation is consideredmedically necessaryfor individuals with Parkinson’s disease when the following criteria have been met:"

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